In case of accident or illness, I request that the representative of the parish catechetical program contact me, If I am unable to be reached, I hereby authorize this representative to call the physician indicated above and to follow the physician's instructions. If it is impossible to
contact this physician, the representative of the parish catechetical program may make whatever arrangements seem necessary. I agree to
assume the financial responsibility for any diagnosis, treatment and/or medication deemed necessary.
To the best of my knowledge all information given is accurate and complete. I hereby consent to, and authorize the necessary procedures
that been stated above.

I agree

I understand that photos of my child(ren) may be taken and used in Parish publications including web and print media.